Abstract P6-11-06: Efficacy of scalp cooling in preventing chemotherapy-induced alopecia in breast cancer patients: A retrospective, comprehensive review of 330 cases of Brazil

Abstract

Background: Chemotherapy-induced alopecia (CIA) is a distressing adverse effect of many chemotherapy (CT) agents. New strategies for prevention of CIA have been studied. Scalp cooling has been reported to prevent CIA. We conducted a retrospective study aimed to assess the efficacy of scalp cooling in preventing CIA among women receiveing chemotherapy for breast cancer. Methods: Was included clinical data of breast cancer patients at the Oncoclinicas Group from July/2015 to March/2017. All patients were elected to use scalp cooling to prevent CIA. Cooling started 30 minutes before infusion and was maintained throughout the infusion of the treatment and extended for 90 minutes after infusion. Degree of hair loss was rated by nurse assessment using CTCAE v4.0 scale in grade zero (without alopecia), 1 (<50%) or 2 (>50%), digital photographs and clinical assessment. Assessments were made before each chemotherapy treatment and at a follow up visit between 3 weeks and 3 months after the completion of chemotherapy. Success was defined when there was G0 or G1 alopecia at the end of the treatment, and failure when finished with G2 alopecia and patient withdrawal due to alopecia. Results: 330 patients were included. 283 with localized breast cancer and 47 with metastatic disease. 188 patients (57.0%) completed all tratment with scalp cooling. 72 patients (21.8%) withdrew from cryotherapy for alopecia of any degreee, 51 patients (15.4%) gave up cryotherapy for complaints unrelated to alopecia and 19 patients (5.8%) had their treatment interrupted due to external factors (progression of disease, change of CT protocol, among others). Among patients who completed chemotherapy (n=188), the degree of alopecia at the end was G0 = 27, G1 = 138, G2 = 23. Thus, the overall success rate with cryotherapy was 63.5%. CT protocols initiated with doxorubicin and cyclophosphamide, followed by taxanes, presented a success rate of 50%. The combintation of docetaxel and cyclophosphamide showed success of 71.9%. Scalp cooling: chemotherapy regimes and alopeciaChemotherapy (CT) regimeCompleted CT G0Completed CT G1Completed CT G2Abandoned SC G1Abandoned SC G2AC02011AC/taxanes65152527AC non sequential11100D alone or combi no AC319221DC6401134EC at 2nd part of CT01000EC at 1rst part of CT00111P alone or combi no AC613014No AC21000AC at 2nd part of CT310310Total27138233438A: doxorubicin; C: cyclophosphamide; D: docetaxel; E: epirubicin; P: paclitaxel; combi: combination In addition to alopecia, headache and cold sensation were common reasons for cryotherapy withdrawal. Conclusions: Scalp cooling appears to be effective in preventing CIA among breast cancer patients who underwent chemotherapy. Studies involving a psychological approach to the expectation and experience of alopecia with cryotherapy and better management of pain are necessary to increase adherence to treatment. Citation Format: Silva GB, Moreira RB, Gimenes DL, Silva ACP, Araújo BRC, Pacheco BP, Paiva RdCP, Sutmoller C, Hammermuller LMJ, Lima RO, Pimentel RVIA, Simões ÂAB, Mathias CMC, Lessa ÂMC, Costa MAD, Martins LCA, Ferrari BL. Efficacy of scalp cooling in preventing chemotherapy-induced alopecia in breast cancer patients: A retrospective, comprehensive review of 330 cases of Brazil [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-06.

Update Breast Cancer 2018 (Part 2) – Advanced Breast Cancer, Quality of Life and Prevention

“…Four studies investigated the efficacy of scalp cooling during therapy. The success rate during treatment with anthracyclines was 50 – 62.5% 29 , 30 . Menopausal status, therapy setting (neoadjuvant versus adjuvant) and dose density had no impact on alopecia rates.…”

“…Menopausal status, therapy setting (neoadjuvant versus adjuvant) and dose density had no impact on alopecia rates. The problem is the high rate of around 30% of patients who discontinue scalp cooling because of the pain, with about half of these patients subsequently losing all of their hair 29 . It should be noted, however, that grade I loss of hair after scalp cooling was also rated as a success in the studies.…”

“…Problem ist die hohe Abbruchrate der Kopfhautkühlung von ca. 30% aufgrund von Schmerzen, wobei die Hälfte dieser Patientinnen dann eine kompletten Haarverlust erleidet 29 . Allerdings wird als Erfolg der Kühlung auch ein Grad-1-Haarverlust in den Studien bewertet.…”

Update Mammakarzinom 2018 (Teil 2) – Fortgeschrittenes Mammakarzinom, Lebensqualität und Prävention

“…Gleich 4 Studien untersuchten die Effektivität der Kopfhautkühlung unter der Therapie. Beim Einsatz von Anthrazyklinen lagen die Erfolgsraten bei 50-62,5 % [29,30]. Es zeigte sich kein Unterschied nach Menopausenstatus, Therapiesituation (Neoadjuvanz vs. Adjuvanz) oder Dosisdichte.…”